reducing pred

[granelliheywood]

going down from 5mg to 4 mg today last time I did this I had a flare went back up to 10 mg and now after 5 months will try again advice please

[DorsetLady PMRGCAuk volunteer]

Hi,

Why don't you try going down by just 0,5mg this time. Once I got to 7mg I only reduced by 0.5mg each time, the smaller the drop the easier for the body to cope with. Plus are you using a slow form of reduction, that is over a few weeks than 'overnight' - that also is easier for your body to withstand. And, if you get into the second week, say, and don't feel right, then just revert to 5mg for a few more weeks before trying again. As we always- it's not a race to get to zero. 

Hopefully, with both of the above, you will be successful this time, but don't get stressed about it, 5mg is viewed as being a fairly low dose anyway with few side effects. I know we all want to be free of Pred, but unfortunately some cannot, and that's usually because the adrenal glands are not working properly.  Have you had yours tested? 

[betty1943]

Good advice from DorsetLady.  When I was reducing in the lower figures, I tried going up and down for a week to try and trick the adrenal, that is 5 to 4, then back up to 5, then 5 to 4, then up to 5.  Then two days on 4 and one on 5.  Kate Gilbert did a similar thing in her book, have you got her book?  Well worth buying.    

Good luck this time let us know how you get on.

[PMRpro Ambassador]

Try this approach:

healthunlocked.com/pmrgcauk...

It, or similar plans, have been used by many people on the 3 different UK PMRGCA forums and has helped them get lower than every before and with fewer problems. It is currently being used in a clinical study in the north of England. It is fully explained there.

It has been said by top experts for years that in PMR no reduction should be more than 10% of the current dose - so below 10mg, even 1mg reductions are too much. This method spreads it over weeks and your body isn't being asked to deal with several consecutive days of a new dose that is a big change.

But remember: you are NOT reducing relentlessly to zero! You are looking for the lowest dose that gives you the same result as you have had before. If there is an increase in symptoms - you are not ready to go there yet. As long as the underlying autoimmune disorder that is the cause of the inflammation, pain and stiffness of PMR or GCA is still active you will need some pred to manage the daily dose of new inflammatory substances that is shed ever morning and causes the new lot of morning stiffness etc.

At this stage, too, your body is having to start to produce cortisol, the body's own corticosteroid which is essential for life. At higher doses of pred it doesn't have to there is enough "artificial" present but from here on do go very slowly to give it a "graded return to work" - or you may have other problems!

[HeronNS]

I'm reducing at the same level right now.  Have done it by .5 mg increments.  Thinking I will be pausing at 4 mg a little longer than I have at the higher levels....  Have been working on this taper for nearly a month and still only part way through....  I'm sure an overnight drop from 5 to 4 would have been a big mistake!

[Annodomini]

I hope you are using the dead slow and almost stop procedure. For example, this week I am starting to taper from 4 to 3.5 and so will take 4mg on 6 days and 3.5 on only one day.  Eventually I'll be taking 3.5 every day - all being well.